Hi all, I had a medication review with my GP today and he has told me that he’d like me to consider reducing my Amitriptyline dosage (I’ve been taking 20mg since May '22, started with 10mg Feb. '20) due to the increased risks of alzheimers through prolonged use of the drug. I should point out that my vestibular specialist prescribes my dosage, so this is just my GP reviewing all my prescriptions at the same time so I can continue to get them on repeat. It’s not something I’d heard before and wondered if anyone had also been told this? I have a rehab appointment on Friday and will take my specialist’s opinion over my GP, but can’t deny it has unsettled me a little. I also take Betahistine and am reluctant to change my meds as I’m returning to study in September and need as much stability as is possible!
depends on your age…if you are past 50 it is a legit concern, but the benefits might outweigh the risks if it helps you significantly.
its a risk assessment game, but the dementia risk is well documented for anticholinergic drugs.
Yes, my oto-neurologist told me I needed to get off Amitriptyline “at some point” as use of it forever was “not healthy” (ie for exactly these reasons). I was only on 20mg but this was still a concern long term. It’s partly why I did not go higher.
Agree with @sheepdog_lord, it’s a balance though. What to do?
I believe there is also another factor to consider: that eventually it impairs your ability to fully compensate and you need to let the brain “work stuff out” unhindered. That strategy worked for me as it turned out and coming off Amitriptyline after 1.5 years of use was the right call despite a slight increase in symptoms initially. The only symptom I have left Amitriptyline never helped anyway (tinnitus).
I did actually immediately feel relief of two side effects. I suddenly felt mentally “brighter” and my bowel movements normalised.
If you want a timing marker I’d say if you are no longer forced to lie down periodically with horrific basilar migraines and you have the big migraine attacks under control I would give titrating down a go. If the big attacks come back it might be too soon.
Somehow I knew when it was time.
you can read a little more in-depth about it here. although i will say that its probably better to have your migraine under control as migraine is also associated with dementia too
independent of prophylaxis?
yes – and more frequent/chronic migraine has greater association with dementia than episodic migraine
How long was it before you saw an improvement if you don’t mind me asking? I’m starting a 3 year Post Grad degree in September and really need to be stable for that as will be working as well!
After giving up Amitripyline? Well immediately only a slight increase in symptoms (which surprised me, I thought I’d revert more), and a gradual improvement over about a year or 2. I’d say I’ve improved even more and very slowly. There is still something clearly up with my left ear though, but I’ve more or less compensated from a vestibular perspective and now rarely get any neurological symptoms.
Goodness, you’ve done so well! You’ve certainly given me a lot to think about, thank you. I don’t want to make any changes until my body has had time to adjust to the extra demands of studying - will speak to my rehab physio on Friday as well. Thanks so much!
Yeah, take it slowly, and good luck with the study!
Or maybe the study shows that dementia patients are more likely to use antidepressants than the general populous.
To be honest 50% increase in chances sounds a lot… but what we’re taking about is the difference between a 2% chance and a 3% chance…
study is cohort matched with other non-anticholinergic drugs, so this confounding effect is not present…